By Antonella Surbone, MD, PhD, FACP
New York University
Each first-year Fellow at the Department of Chemotherapy of the National Cancer Institute in Milan was assigned two rooms with four beds, one for men and one for women patients. It was my third week in January 1983, when within a few hours four of "my" patients died: all young, two younger than me. We all desperately tried to save them, and at six o'clock the next morning I was still on the ward. The Chairman always arrived very early, gathered information about what had happened during the night from Head Nurse Karina, then retired for a few hours into his studio to write: he was a highly educated man, full of interests. That morning he saw me with my eyes full of tears. He ordered me to wait for him in his studio: too distraught with grief to worry about why he wanted to see me, still I was not at ease.
Gianni Bonadonna came shortly after with a plastic cup taken from the distributor. He handed it to me, saying, "I brought you some hot chocolate, you are from Turin, you should like it." Very seriously, he added, "Now you stay here and pour all your tears, but then you wipe your eyes, fix yourself and start smiling before you get out of here. Because remember that all patients today will look at you to read in your eyes and smile if they are going to live or die. "
In the United States, where he had sent me, I recounted this episode at a time when someone would speak of him as an "ice scientist," before he was struck by a cerebral hemorrhage at the age of 61 at the height of his activity and creativity. That episode was the greatest teaching that I received from Dr. Bonadonna, along with countless others about oncology and statistics necessary to provide the best standard and research care to our patients.
He passed away on September 7 at the age of 81 years in Milan. I remember him as severe, rigorous, and highly experienced. His department was run in an American style from the beginning: physicians and nurses were treated with equal respect for the work that each one did, and patients participated in the testing of new drugs and therapies after giving their informed consent. Supported in part by the National Cancer Institute in Bethesda, Gianni Bonadonna and his collaborators conducted some of the first clinical trials that would contribute to change the future of patients with cancer in the world, including experimental testing of doxorubicin, a drug still essential in the treatment of cancer; adjuvant chemotherapy for breast cancer that helps prevent relapse; curative therapies of Hodgkin’s disease with low risk of infertility; and numerous others.
Many will speak of all the professional accomplishments and awards that he obtained during his life. I rather wish to remember something more ordinary and personal. Like many of his Italian colleagues, he would see several patients in private consultation, before and during chemotherapy, personally taking the major therapeutic decisions and then sending recommendations to his assistants or fellows. Each consultation was handwritten with a wonderful calligraphy using a green pen. It was enough for me to see the green color to feel both intimidated and safe at the same time.
When I decided to return to the United States, to Memorial Sloan Kettering Cancer Center where Dr. Bonadonna had began his career as an oncologist with David Karnofsky, he did not look happy at first. On my last day in Milan, though, he took me out to lunch and said, "You'll see that soon you will find yourself using all what you learned here by example. " He was right.
Life was merciless with Gianni Bonadonna, a prisoner for 20 years of aphasia after his stroke. Yet he found the strength to write about the humanistic side of medicine, which his illness and rehabilitation had made more transparent, though it had always been part of him. With eyes full of tears again, my final thoughts go to last Saturday, when I received an email: "At last I hear from you and hope to hug you again soon in person... As you can see, I am working on a new book... Keep in touch! Gianni."
Then, a few evenings ago, the email of his assistant Roberta Negri (to whom he has dedicated the book Appointment with the Eternal Father) began: "It is with true sadness…"
Many are grateful to him for contributing so much to transform cancer from a dark evil into a disease that, although charged with risks and serious medical and psychosocial implications, is increasingly treatable or with which people can live longer and longer. Without any false triumphalism, but being able to smile more to our patients: Thank you, Gianni.
Original publication: Il mio ricordo di Gianni Bonadonna maestro della ricerca oncologica. By Antonella Surbone, La Stampa, TuttoScienze, September 9th 2015: 26-27. Translated by Dr. Surbone and republished with permission of La Stampa.
A note from Dr. Surbone
After a massive stroke and years of rehabilitation through which he never recovered his autonomy or speech, Gianni Bonadonna wrote many books on medicine and the patient-doctor relationship, conveying to a large public the true meaning of clinical medicine: “A fusion of science and art, coupled with the privilege to take responsibility for the health of a person… to ease pain, restoring an organ’s function, facing the intellectual challenge to solve clinical problems…” His illness, and the experience of physical and existential pain that came with it, brought to first stage the importance of communicating with one’s patients, sitting close to them, caring for them in their wholeness and caring for the relationship itself.
In his latest book, Appointment with the Eternal Father, he vividly paints his life, while "speaking" to God for the first time since he was a boy, and asking Him questions. He starts with letters to his parents, who greatly shaped his strong character, and then proceeds with short and vibrant stories about his professional and personal life from his time at Memorial Hospital (now Memorial Sloan Kettering Cancer Center) in New York in the early 1960s, to the many years of successful clinical trials in Milan, Italy, until his long final 20 years.
“I had a stroke and for the first time the diagnosis was not mine… I met the [same] fear of my patients… I would like to live it all, this poor life of mine, from which I am excluded,” he wrote. “I fight, think and try to narrate myself hoping that You will benevolently listen to me and look at my life and make me feel that You are here.”
Gianni Bonadonna in collaborazione con Alberto Scanni. Appuntamento col Padreterno. Collana Le Querce (diari) Montedit, Vardellino (BG), 2014. (Personal translation of excerpts by Antonella Surbone).